Antimicrobials V2 Flashcards
Penicillin G is administed
IM or IV
Penicillin V is administed
orally
mechanism of penicillins
covalent binding to transpeptidases/PBPs, cross-linking, activation of autolysins
penicillins are bacterio-
cidal
block penicillin excretion with
probenecid
most ICWS inhibitors exibit
time dependent cell killing
clinical use: Pen G and Pen V
gram +
clinical use: anti-staphylococcal penicillins
beta-lactamase resistant
HHEELPSS
H. flu, H. pylori, E. coli, Enterococci, Listeria, Proteus mirabilis, Salmonella, Shigella
anti-staphylococcal penicillins
nafcillin, methicillin, isooxazolyl
extended spectrum antibiotics
ampicillin, amoxacillin
clinical use: extended spectrum penicillins
increased gram - activity
anti-pseudomonal penicillins
ticarcillin, piperacillin, mezlocillin
clinical use: anti-pseudomonal penicillins
effective against psuedomonas and some other gram -
due to rapid emergence of resistance with pseudomonas, use anti-psuedomonal penicillins in combination with
aminoglycosides or fluoroquinolones
adverse effects of penicillins
ampicillin rash
hypersensitivity: complete cross-linking
seizures w/ renal failure
resistance to penicillins
inaccessible PBPs (MRSA or gram -)
B-lactamase production
to reduced beta lactamase activity, administer penicillins with
b lactamase inhibitors
b lactamase inhibitors
clavulanic acid (augmenin)
sulbactam
tazobactam
clavulanic acid….
dramatically increases effects of pens
mechanism of cephalosporins
b-lactams, similar to pens
pen-sensitive patients may have cross reactivity with
cephalosporins
cephalosporins are bacterio
cidal
1st gen cephalosporins
cefazolin
cephalexin
2nd gen cephalosporins
cefuroxime
cefotetan
cefactor
3rd gen cephalosporins
ceftriaxone
cefotaxime
ceftazidime
cefpdoxime
4th gen cephalosporins
cefepime
cefepime exhibits _______ resistance
cephalosporinase
clinical use: 1st gen cephalosporins
gram +
clinical use: 2nd gen cephalosporins
some gram -, less gram +
clinical use: 3rd gen cephalosporins
serious gram - resistant to other b-lactams
clinical use: 4th gen cephalosporins
pseudomonas and cephalosporinase resistance
adverse effects: cephalosporins
irritation from injection
renal toxicity- enhanced by aminoglycosides
hypersensitivity
vitamin K deficiency
what antibiotics gives the Disulfiram effect?
cefotetan, bleeding and platelet disorders
what antibiotics gives the Disulfiram effect?
cefotetan, bleeding and platelet disorders
mechanism: azteronam
b lactam
clinical use: aztreonam
psuedomonas B-lactamase resistant
can azteronam cross the blood brain barrier?
yes
do azteronam exibit cross reactivity in pen-sensitive patients?
no
mechanism: imipenem
b lactam
clinical use: imipenem
broad, gram + and -
can imipenem cross the blood brain barrier?
yes
administration: imipenem
IV only
what should you coadminister with Imipenem?
cilastatin
inactivated by renal peptidase
meropenem
dipeptidase resistant carbapenem
does imipenem exhibit cross reactivity with pen-sensitive patients?
yes but incidence is low
mechanism: vancomycin
inhibits transglycosylation
vancomycin is bacteri-
cidal for gram +
vancomycin works synergistically with
aminoglycosides
vancomycin is given IV for
systemic use
vancomycin is given orally for
C. diff
clinical use: vancomycin
MRSA
adverse effects: vancomycin
flushing syndrome
renal and oto toxicity esp w/ aminoglycosides
mechanism: fosfomycin
inhibits cytoplasmic step in cell wall precursor synthesis
inhibits MurA blocking PG synthesis
clinical use: fosfomycin
gram + and gram -
single dose therapy UTI
fosfomycin is synergistic with
b lactams
aminoglycosides
fluoroquinolones
adverse effect: bacitracin
nephrotoxic
administration: bacitracin
topical only
pharmacokinetics: fosfomycin
G6P transporter
mechanism: colistin
act as detergents
clinical use: colistin
gram -
administation: colistin
topical due to renal toxicity
colistin is used as salvage therapy for
acinetobacter, pseudomonas, enterobacterieae
mechanism: tetracycline
reversible binding to 30S subunit
tetracycline is bacterio-
static
what class chelate metal ions?
tetracycline
what class should not be administered with calcium products?
tetracycline
can tetracyclines cross the placenta?
yes
excretion of doxycline
fecal
excretion of most tetracycline
urine
clinical use: tetracycline
broad spectrum
mycoplasma, chlamydia, rickettsiae
lyme disease
adverse effects: tetracycline
GI irritation
superinfections
liver damage
photosensitization
calcium chelation
resistance to tetracyclines
mainly efflux pumps
altered ribosomal proteins
glycycycline
newest tetracycline
retain antibacterial spectrum but overcome resistance